Grants for Home Improvement in Pennsylvania

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					              Guidelines for Safe Kids Pennsylvania Mini-Grants
             as funded by the Pennsylvania Department of Health
                                    July 1, 2007 – May 30, 2008

           The following packet is for those Chapters / Coalitions applying
                        for the New Prevention Mini-Grant.

Types of Mini-Grants Available:
   (1) Chapter Start Up funds ($500.00/chapter)
   (2) New Prevention project ($1,500.00/coalition/chapter)
   ** Note: Each Chapter / Coalition is eligible for only one of the following two choices:
   (3) Bicycle Helmets or Smoke Alarms funds (100 smoke alarms or 150
       bike helmets per each coalition/chapter)

1. General Provisions for all Mini-grants

   A. Eligible Mini-Grant Applicants

       Eligible applicants are Safe Kids Pennsylvania Coalitions and Chapters and any
       organization that is in the process of applying to Safe Kids Pennsylvania to become a
       chapter. To be considered for a Mini-Grant, the applicant must submit the appropriate
       application forms.

       The application must be submitted on the appropriate attached Mini-Grant Application
       form or on 8½ X 11 white paper in a format which contains the required information in
       the same order as shown on the Mini- Grant Application forms. Two copies of the
       application must be submitted to Safe Kids Pennsylvania by June 6, 2007.

   B. Reporting Procedures

       The Mini- Grant recipient must submit two copies of the final report by May 30, 2008.
       A report form will be distributed in February, 2008. The report must contain the
       following:
              Number of events;
                      Held
                      Participated in
              Number of children who received intervention;
                      Educational materials
                      Safety items
              Evidence that collaboration with State and Community Health Improvement
                 Partners occurred;
              Summary of the program accomplishments in accordance with the recipients
                                     New Prevention Mini-Grant Application
                                                 Page 1 of 10
         work plan;
        Evaluation results and outcomes;
        One copy of materials developed for and used in the project;
        Copies of any news articles related to the recipients grant activities.

C. Letter of Agreement/Contract
  The Mini- Grant recipient’s fiscal organization will receive a Letter of Agreement
  (LOA) from the Central Susquehanna Intermediate Unit, the lead agency for Safe Kids
  Pennsylvania, upon grant approval. Once the LOA is signed by the grantee’s fiscal
  organization and returned to Safe Kids Pennsylvania the Mini- Grant recipient will
  receive 100% of grant money for Start-Up, 50% of the grant money for New Prevention
  or all of the helmets/smoke alarms. All payments are contingent upon availability of
  funds from the Pennsylvania Department of Health. As part of this agreement, the
  recipient must agree to federal funding provisions such as the Americans with Disabilities
  Act, Equal Opportunity for the Handicapped, and Equal Employment Opportunity. A
  budget revision is required to be filed with, and approved by Safe Kids Pennsylvania in
  advance if there is a ten percent (10%) or greater change in a category of the approved
  budget. Changes in a category of less than ten percent (10%) do not require a budget
  provision.

D. Invoicing Procedures

  Enclosed with the LOA will be a blank expenditure report. This report, which will
  outline the recipient’s expenditures, must be submitted by May 30, 2008 in order to
  obtain the second half of the grant money. The Mini-Grant recipient will receive
  payment for the second half of the grant money after the expenditure repor t has been
  submitted to Safe Kids Pennsylvania and after Safe Kids Pennsylvania receives payment
  from the Pennsylvania Department of Health. Payment is contingent upon funding from
  the Pennsylvania Department of Health. The expenditure report must contain detailed
  descriptions of purchases. This documentation will allow for verification of
  expenditures. Insufficient documentation may delay payment. The Mini- Grant recipient
  should expect payment 3-4 months from the date the expenditure report was submitted to
  Safe Kids Pennsylvania. Again, the Mini-Grant recipient must submit the
  expenditure report by May 30, 2008 with the final report.

E. Developing Materials

  All educational materials and safety items developed for the grant activities must be pre-
  approved by the Pennsylvania Department of Health. This process usually takes three
  weeks to six weeks, so submit materials as early as possible. Send a copy of materials
  with an Office of Communications Request for Approval Form (page 5 of Guidelines) to:

                 Violence & Injury Prevention Program
                 Pennsylvania Department of Health
                           New Prevention Mini-Grant Application
                                       Page 2 of 10
               Health & Welfare Building
               Seventh & Forester Streets, Room 1008
               Harrisburg, PA 17120
               Fax: (717) 783-5498

You will be notified by fax of any revisions that are needed prior to distr ibuting the
materials. Expenses for safety items and educational materials that have not been
approved by Safe Kids Pennsylvania will not be reimbursed.


1) Educational Materials (Brochures, newsletters, flyers, press releases, public service
announcements, etc.)

All educational/informational materials developed under this grant must contain the Safe
Kids Pennsylvania logo, which is available on the Safe Kids PA website
www.pasafekids.org, and the following funding clause:

"This project is supported by the Pennsylvania Department of Health and the Preventive
Health and Health Services Block Grant from the Centers for Disease Control and
Prevention (CDC)."

This can usually be placed in small type at the end of a brochure, newsletter or flyer. It
may be incorporated into the text of a press release, media advisory, or public service
announcement.

2) Safety Items (Reflective materials, belt clip strobes, and other small, inexpensive
safety items)

These items may be allowable for New Chapter Startup or New Prevention Project Mini-
Grants if they contribute to the injury prevention objectives of the coalition or chapter's
mini- grant. They must contain the Safe Kids Pennsylvania logo and (space permitting)
the PA Department of Health logo available on the Safe Kids PA website:
www.pasafekids.org. An example of the wording and logos on the item must be sent
with a communications approval form to the PA Department of Health for approval
before purchase and distribution. Grant recipients must list all safety items they wish to
purchase in the original budget.




                          New Prevention Mini-Grant Application
                                      Page 3 of 10
4.   Guidelines for New Prevention Project
     Purpose:
           The purpose of this Mini-Grant is to assist communities in implementing and
           evaluating interventions aimed at preventing intentional and unintentional injuries
           among children ages 14 and under.

     Eligible applicants must complete the following application forms:
            General Information
            New Prevention Program Application
            Work plan
            Budget

     Maximum Allowable Grant: $1,500.00

     Mini-grant Requirements:

          Focus on a childhood injury that has been identified as a need in the community,
           based upon injury data, and has not been adequately addressed in the community
           by existing injury prevention programs. If local injury data is not available, the
           applicant may use estimates from national or state data sources.

          Focus on modifying behaviors to prevent injuries from occurring rather than
           treating injuries after they happen.

          Use proven prevention strategies and interventions recommended in Healthy
           People 2010 Objectives (http://www.healthypeople.gov/) or other research-based
           references.

          Focus on low- income children. Note: research shows that low- income children
           are most likely to be injured and least likely to have bicycle he lmets, home smoke
           alarms, and other safety devices.

          Applicants must include an evaluation plan that describes how the project will be
           evaluated, suggestions for improvement, and how it impacts the target population.
           At a minimum, the evaluation must provide the number of children under age 15
           who benefited from the intervention (smoke alarm, bicycle helmet, trigger lock,
           etc.) and a pre- and post- intervention survey/test to determine use of the safety
           device and other outcomes of the project.

     Ineligible Items Include:
            * T-Shirts                                       *   Tote Bags
            * Items with no safety purpose                   *   Food
            * Furniture                                      *   Office Equipment
            * Space Rental                                   *   Custodial Services
            * Bus/Mass Transportation
                              New Prevention Mini-Grant Application
                                          Page 4 of 10
Please also include:

Fax no.: _____________________
E- mail address (optional) _____________________________

All educational materials and safety items developed for the project must be
pre-approved by the Pennsylvania Department of Health. This process usually takes
three weeks, so submit materials as early as possible.

Send a copy of materials with this form to:

               Violence & Injury Prevention Program
               Pennsylvania Department of Health
               Health & Welfare Building
               Seventh & Forester Streets, Room 1008
               Harrisburg, PA 17120
               Fax: (717) 783 – 5498
                         New Prevention Mini-Grant Application
                                     Page 5 of 10
                                          MINI-GRANT APPLICATION
                                               GRANT PERIOD
                                         JULY 1, 2007 – MAY 30, 2008


INSTRUCTIONS:                    This page must be completed by every coalition/chapter applying for New
                                 Prevention Mini-Grants. Be sure to include a list of Coalition members
                                 with the application.



Program Title:

GENERAL INFORMATION:
(please type or print clearly)


Local Coalition/Chapter:

Coalition Coordinator:
Signature:                                                                          Date:


Address:

City:                                                              State:         Zip:


Telephone:                                  Fax:                                  Email:

       Please complete the section below even if the information is the same as above. The Letter of
                       Agreement and grant money will be issued to the following:

Name of Organization
to receive grant funds:

Project Director:
(if not the coalition coordinator)

Signature:                                                                          Date:


Address:

City:                                                              State:         Zip:

Telephone:                                  Fax:                                  Email:

                                          New Prevention Mini-Grant Application
                                                      Page 6 of 10
                              New Prevention Project
                              Mini-grant Application
                                   (please type or print clearly)


INSTRUCTIONS: To be completed only if applying for new prevention project
funds.
1.     Coalition/chapter name:
2.     Project Goal:
3.     Year 2010 Objective(s) to be addressed:



4.     Project Description:




5.     Description of Target Population:



6.     Estimated Number of Pe rsons to be Served:
       Number of Adults:
       Number of Children:

       Number of Low Income Families:

7.      Evaluation Plan:
Describe how the project will be evaluated to determine, as a minimum, the number of children
under age 15 who received the use of intervention and a pre and post-intervention
survey/observation to determine changes in behavior due to the use of the safety device or
practice.
8.      Budget. (Not to exceed $1500.00)
     Budget must contain detailed descriptions of purchases.
     Complete the budget form on page 6.
     Itemize each budget category.
     PLEASE USE WHOLE DOLLAR AMOUNTS

                              New Prevention Mini Grant Application
                                          Page 7 of 10
             Workplan -- Program Objectives and Activities
                                               COMPELTION       AGENCY          # OF
OBJECTIVES   ACTION ITEM
                                                  DATE        RESPONSIBLE   PARTICIPANTS




                      New Prevention Mini-Grant Application
                                  Page 8 of 10
                       SAFE KIDS COALITION MINI-GRANT
                              2007-2008 Budget Form

                        Safe Kids (Chapter / Coalition Name)

                                Funding Agency Name



CATEGORY                                                       TOTAL AMOUNT

Contracted Services:




Equipment:




Supplies:




Other: (Specify)




Total


 *Please itemize and be as specific as possible with each category of your budget.*
                **PLEASE USE WHOLE DOLLAR AMOUNTS**



                            New Prevention Mini-Grant Application
                                        Page 9 of 10
                                    Example

                    SAFE KIDS COALITION MINI-GRANT
                          2007-2008 Budget Form

                      Safe Kids        Cumberland County
                                      Chapter / Coalition Name

                     Cumberland County Health Department
                                 Funding Agency Name



  CATEGORY                                                       TOTAL AMOUNT
  Contracted Services:

  Speaker for Carlisle Car Show - $200
      (speaker fee and mileage)                                  $200.00



  Equipment:

  Coalition Banner - $150.00
                                                                 $150.00



  Supplies:

  1000 Reflective zipper pulls - $865.00
     ( .80 cents each, $45.00 set up, $20.00 shipping)
                                                                 $897.00
  4 reams Pape r – $32.00 ($8.00 each)


  Other: (Specify)
  28 Ski Helmets - $252.00 ($9.00 each)
                                                                 $252.00



  Total                                                          $1499.00

*Please itemize and be as specific as possible with each category of your budget.*
               **PLEASE USE WHOLE DOLLAR AMOUNTS**

                         New Prevention Mini-Grant Application
                                     Page 10 of 10

				
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